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Fights We Can Win

Image: SP, Manifestatie voor thuiszorg / Flickr / CC BY-NC-ND 2.0

Fights We Can Win

The Dutch Socialist Party’s Health Care Intervention

May Naomi Blank (transl. by Loren Balhorn)
,
03.04.2017

Delivering his acceptance speech as the newly elected leader of the Socialist Party of the Netherlands (SP) towards the end of 2015, Ron Meyer informed his comrades they "have to do things differently. […] Not a little bit differently, but completely different." The former campaigner from the Federatie Nederlandse Vakbeweging (FNV) trade union federation had previously organised Dutch youth in a campaign to raise the minimum wage, and now his leadership would mark the beginning of a new, militant SP campaign for a public health care system. Organising around the slogan "Nationaal ZorgFonds" (National Health Care Funds), the party kicked off an initiative six months after Meyer’s speech that progressive and Left forces across Europe can learn from. Some quarter-million supporters together with various political parties, unions, and social movement organisations signed a common appeal demanding the de-privatisation of the health care system, placing responsibility for all health care costs in the hands of a state-run health care service. On the ground, 10,000 protesters marched through the capital Den Haag in mid-February to lend force to the demand. The ZorgFonds campaign also provoked debates within the Netherlands’s Labour Party (PvdA) and the FNV – incidentally the largest labour federation in the country. The left-leaning "Party for the Animals" (PvdD), the 50PLUS pensioners’ party, and the Pirate Party also announced their support.

The campaign for a national health care fund was the result of years of preparatory work, after the SP party council originally decided upon the strategic turn in 2014. In years prior, the party with 14 seats in the lower chamber of parliament had run several smaller campaigns with limited success. SP members now sought to focus on one large nationwide campaign, arguing it made more sense to pick fights they stood a chance of actually winning rather than limit themselves to defensive fights against neoliberal reforms. Party activists hoped that an offensive strategy to win real improvements could also help chip away at the dominance of neoliberal ideas in Dutch society.

Fighting for a public health care system fit into this framework well, as health care is obviously a topic that personally effects a majority of the population. A 2016 survey conducted by nu.nl, the largest news portal in the Netherlands, concluded that 63% of those surveyed thought health care was the most important election issue, above the immigration question that so visibly dominated the right-populist PVV’s campaign. Moreover, both the SP and the FNV had already accrued some experience in the area. Lilian Marijnissen, for example, the third candidate on the SP’s 2017 parliamentary list, organised the FNV’s first offensive organising campaign in the health care sector after its restructuring in the 2000s. The Dutch health care system today is one of the most intensively neoliberalised public sectors in the country, but was only restructured a decade ago. Thus, most people still remember the old system, making deprivatisation appear as a plausible option to many Dutch citizens.

The Dutch Health Care System: Privatisation, Exploitation, and an Oligarchy of Insurers

Beginning in the 1980s, the notion that competition between private health insurers would best regulate the health care sector became increasingly dominant across the Netherlands. Eventually, a conservative government led by Prime Minister Jan Peter Balkanende privatised the formerly semi-public health care system in 2006. Health insurers were now allowed to make profits, triggering a wave of mergers on the insurance market. Today, 90% of the insurance market is dominated by four large companies while individual costs have risen tremendously, as a lump sum for surgeries, prescription drugs and other services is now paid by patients themselves. This so-called "personal risk" payment has now risen from 150€ to 385€. Rather than use the new income stream to improve access or services, the health insurers have chosen to rake in the profits instead (1.9 billion euros in 2014 alone).

Bureaucratic red tape has not been reduced by the reforms, either: instead, every medical institution is now obliged to negotiate contracts with multiple insurers. The results of this change can be seen in the sums spent on overhead at the executive levels of Dutch hospitals, which are four percent higher than their British or Canadian counterparts on average. The reform has permitted hospitals and so-called "care providers" (doctors, dentist offices, etc.) to earn profits and compete with each other for contracts with the health insurers, strengthening the insurance industry’s hand in negotiations. Critics of the health care reform fear that competition pushes hospitals to systematically ignore medical errors rather than work together towards qualitative improvements, not wanting to risk their untainted public image. Moreover, the reform has led to the creation of a two-tiered health care system, as insurers are now allowed to offer various insurance policy "packages", such as an affordable basic package alongside several more expensive ones covering additional treatments. The insurance companies are even allowed to raise deductibles to 885€ in exchange for lower monthly premiums, particularly attractive for low-income customers.

Working conditions in the health care sector also declined in the wake of the reforms. To begin with, precisely which services are covered by insurers is determined in detailed descriptions of the individual treatment steps for a given illness, the so-called "Diagnose Behandel Combinatie", with the exact price being negotiated between health insurers and hospitals. This has led to a growth in paperwork and bureaucracy, while increasing the pressure on care workers at the same time. Further exacerbating the situation is the fact that the health insurance companies refuse to pay for activities not of an explicitly medical nature. In the context of elderly care, this means that care workers are no longer remunerated for cleaning the facility or shopping for patients. These activities, once performed by trained staff, are now often done by unskilled workers, students, or temporary employees. For this reason, many retirement homes and care institutions have gone bankrupt. Many of the redundant staff were later re-hired by new firms, albeit usually for significantly less pay and under worse conditions. This widespread hollowing out of labour standards worried the FNV trade unions, one of the Socialist Party’s most important coalition partners. The FNV was clear in its assessment that lowered wages were a direct result of privatisation and thus called for more than just better wages, advancing an agenda to transform the health care system more broadly.

Organizing and Campaigning

Since forming as a small Maoist group in the 1970s, the SP has consistently placed a strong emphasis on health care. Several SP parliamentarians are doctors and medical researchers, and the SP tends to have disproportionately high levels of support in this sector. As neoliberal reforms began to appear on the horizon in the early 2000s, doctors, pharmacists, physical therapists and other health care workers launched a movement of action committees around the slogan "Zorg voor jedereen" (Medical Care for All), attempting to fight hospital closures and other cutbacks. Now a modernised political party with representatives in parliament, the SP supported the campaign and thereby laid the foundation for political cooperation over the long term. An attempt to block the introduction of the new health care law in 2004 emerged around the SP campaign "Zorg geen Maarkt" (Health is Not a Market), collecting 13,000 signatures from across the health care sector in several years. The coalition organised demonstrations, conducted symposia, and published academic studies and books on the topic. Held together by various employees’ associations, the coalition attracted care workers, nurses, physical therapists, doctors and pharmacists, while winning many of them over to the party.

After the free market health care reforms succeeded, the SP initially concentrated on the question of outpatient care, where working conditions had also declined dramatically. In 2007, the party initiated a campaign together with nurses and the trade unions called "Stop Uitverkoop Thuiszorg" (Stop Selling Off Outpatient Care). Crowning this successful public relations coup was an SP television commercial highlighting problems in the sector. The video features an elderly woman with a walking aid, who gradually undresses herself in front of the camera while informing viewers that “Conny helped me do the wash for years, but now they say Conny is too expensive. So now a random person comes. After that, another random person. I might as well undress in front of the whole Netherlands.” By breaking social taboos around nudity, the video made waves across the country and was awarded the “Gouden Locki” for best television commercial in 2008. The SP, for its part, used the ensuing media storm to introduce three parliamentary initiatives to improve elderly care.

Working with The Unions

A major component of the SP’s health care sector work in recent years has been its growing cooperation with the FNV trade union. The FNV was once a mere confederation of trade unions, but has now reorganised into one, unified organisation along the lines of "one big union". The union once pursued a relatively corporatist line, oriented towards compromise and closely linked to the Labour Party. This process was halted in 2011 when union chairperson Anges Jongerius supported increasing the retirement age to 66 against a majority of the membership, triggering a deep crisis and subsequent process of organisational restructuring. Today, only the leaderships of the FNV unions remain close to Labour, while more and more members at the intermediate levels identify with the SP – one example being SP chairperson and former FNV organiser Ron Meyer.

The SP now works closely with the FNV in the context of political mobilisations. For example, paramedics conducted a four-week strike in 2015 that raised wages by 7.5%, prohibited temporary employment in the sector, and excused workers above 57 years old from night shifts. The SP delivered a petition to parliament together with the striking paramedics, prompting the Minister of Health to withdraw further privatisation plans until 2020. A further example occurred in February 2016, when paramedics occupied city halls in various Dutch municipalities to draw attention to problems in the care sector. Several activsts were arrested and later assisted by the party, which collected donations to pay their legal fees and fines. These experiences paved the way for the Nationaal ZorgFonds project, the Socialist Party’s most militant campaign to date.

Campaigning for a Public Health Service

The party first presented a plan for a national health service in 2014, calculating how much such a move would cost. From here, a conceptual proposal was developed to abolish the private health insurance companies entirely. Implementing this proposal was, in turn, the goal of the ZorgFonds campaign. Seeking to include as many potential allies as possible, the SP formulated two objectives: firstly, to abolish private health insurance and introduce a public health care service in its place, and secondly, to eliminate the personal risk charge. The national health care fund would become a unified health insurer for all citizens, covering physical therapy, dentistry, and psychotherapy in addition to basic medical care, while the two-tiered health care system would be side-lined by eliminating private insurance packages (the entire programme can be read in Dutch in the ‘Bouwstenen’’ found in the literature list).

The campaign consists of a petition already signed by 250,000 people on- and offline, local informational meetings across the country, and plans for a massive demonstration in front of parliament in Den Haag. Additionally, regional action committees have been formed to distribute political material and collect contact information from interested supporters. The SP wants to activate and politicise people, and thus goes beyond simply collecting and presenting signatures to the government. Supporters write down their names, phone numbers and place of residence in the lists, while three employees at the SP office in Amersfoort call new supporters on a daily basis to invite them to participate. New supporters can, for example, help organise informational meetings, send packages of campaign material to supporters in other regions, or – if they have expert knowledge in the health care sector – contribute to the conceptualisation of a future national health fund. By asking for supporters’ place of residence, campaign organisers can group them according to postal code and send targeted invitations to local events. Many ZorgFonds activists end up joining local SP branches, underlining the deeper impact this organizing strategy can have.

The campaign can already be described as a success. It would have been impossible two-and-a-half-years ago to organise broad public support for any kind of deprivatisation measure. Instead, politicians debated year for year about much the personal risk charge would rise, whereas now all Dutch parties other than the national-liberal VVD promise to reduce or even eliminate the charge. As mentioned above, the campaign also succeeded in triggering debates within the FNV and PvdA. Several local branches of the Labour Party support the ZorgFonds, including its branch in Den Haag. Even Lodewijk Ascher, the Labour Party’s lead candidate, opened his campaign with a speech on 28 January 2017 declaring his intention to abolish the user charge and push back against market mechanisms in health care. The FNV has conducted similar discussions, although the labour movement as a whole has yet to embrace the project. Thus far, the FNV affiliate Zorg en Wilzjin (Care and Health) and its pensioners’ department support the plan, while the FNV membership is yet to vote on the matter.

Critics note that the party has failed to place the topics of migration and racism higher on its electoral agenda despite the growth of the right-populist PVV. They argue that the SP is reducing itself to a "party of care work" by focusing all of its energies on the ZorgFonds campaign. The SP’s positions on migration and international solidarity have been subjects of heated debates within the Dutch and European Left in the past, particularly around whether foreign workers promote "wage dumping" and to what extent the state should support guest worker integration programs. Additionally, the SP has thus far focused primarily on a parliamentary perspective for the campaign. Election day was treated as the campaign’s preliminary highpoint, and now that the SP was more or less defeated, it remains to be seen to what extent the Socialists can apply pressure on coalition negotiations to reach its goals. Could the SP expand the network it built in the health care sector into a movement on the streets? This remains unclear for now, as concrete action plans have been put on hold until after the election.

Despite justified criticisms, the ZorgFonds campaign deserves a closer from activists and progressives outside the country as well. The Socialist Party successfully used a wide-ranging organizing campaign to turn the health care debate around in a shift that has real strategic implications for the movement, as a victory for the campaign could trigger further deprivatisation initiatives in other sectors. Moreover, a victory by the SP and FNV in deprivatisating insurance funds in Netherlands could raise hopes and expectations across the continent.